Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

GYNAECOLOGY AND OBSTETRICS IMAGING
Year
: 2006  |  Volume : 16  |  Issue : 3  |  Page : 377--378

Prenatal sonologic features of simple meconium peritonitis


AK Kharat, R Prathima, A Singh, D Jacob 
 Department of Radio diagnosis, Dr Padm D.Y.Patil Medical College. Pimpri - 18., India

Correspondence Address:
A K Kharat
Flat No 2, Building No 34, Ranakpur Darshan Society, New Alandi Road, Vishrantwadi, Yerawada Pune - 411006
India

Abstract

A 25 yrs old female patient came to our department for routine antenatal ultrasound. Sonography revealed presence of a 24 week live intrauterine pregnancy. During routine screening for congenital anomalies, multiple highly echogenic foci were seen on the visceral peritoneal surface of liver and the parietal peritoneum. However no evidence of dilated bowel/ fetal ascites was detected. No other anomaly was detected.



How to cite this article:
Kharat A K, Prathima R, Singh A, Jacob D. Prenatal sonologic features of simple meconium peritonitis.Indian J Radiol Imaging 2006;16:377-378


How to cite this URL:
Kharat A K, Prathima R, Singh A, Jacob D. Prenatal sonologic features of simple meconium peritonitis. Indian J Radiol Imaging [serial online] 2006 [cited 2020 Jan 19 ];16:377-378
Available from: http://www.ijri.org/text.asp?2006/16/3/377/29023


Full Text

 CASE HISTORY



A 25 yr old female patient came to our department for routine antenatal ultrasound. There was no significant past relevant history of TORCH infections. Previous ultrasound scans were unremarkable.

 IMAGING FINDINGS



Study was carried using WIPRO- GE Logiq 400 MD TM scanner with 3.5- 5 MHz convex array transducer.

Sonography revealed presence of a 24 week live intrauterine pregnancy.

Multiple highly echogenic foci were seen scattered through out the visceral peritoneal surface of liver and the parietal peritoneum. [Figure 1][Figure 2]. Few of the clumped foci demonstrated dense acoustic shadowing. The liver and spleen were devoid of these calcified foci. The gall bladder, both kidneys and urinary bladder was normal. No evidence of fetal ascites or pleural effusion. Fetal lungs and heart were unremarkable. No evidence of dilated bowel loops or other anomaly. Based on these findings a diagnosis of simple meconium peritonitis was made.

 DISCUSSION



Meconium peritonitis is a sterile chemical peritonitis secondary to passage of meconium into the peritoneum [1],[2]. It is a rare condition with a frequency of 1 in 35,000 in neonates. Since some cases occurring in utero may resolve or may be clinically inapparent at delivery, the actual frequency may be higher[3].

This chemical peritonitis results from intrauterine bowel perforation and almost always involves the small bowel [4]. Prenatal bowel perforation usually occurs proximal to some form of obstruction, although this cannot always be demonstrated [5]. The extruded bowel contents provoke an intense peritoneal inflammatory reaction, leading to the formation of dense fibrotic tissue. This tissue calcifies, resulting in the characteristic intraperitoneal calcifications identified prior to birth with ultrasound and after birth with abdominal radiograph.

Pathologically, meconium peritonitis can be divided into

fibro-adhesive (type I), (pseudo) cystic (type II), generalized (type III) and microscopic (type IV).6

Antenatal ultrasound findings of bowel dilatation, ascites and polyhydramnios have been associated with MP [7]. The presence of intraperitoneal calcification, however, is the most common characteristic and consistent finding.[7],[8].

Meconium peritonitis can be simple or complex [7],[8]. The sole presence of intra-abdominal calcification indicates simple meconium peritonitis, whereas an association with ascites, polyhydramnios, and pseudocyst or bowel dilatation constitutes the complex variety. In our case only intraabdominal calcifications were present classifying it as simple meconium peritonitis.

The calcifications appear as linear or clumped foci and are plaque-like in the abdomen, pelvis and the scrotum [7]. Dilated small bowel is seen in approximately 25% of cases and indicates mechanical obstruction leading to perforation [9]. Poly -hydramnios and generalized ascites occur in 60 and 50% of cases, respectively [9].In our case calcifications were present on the visceral peritoneal surface of liver and the parietal peritoneum. However no evidence of dilated bowel/ fetal ascites was detected.

The natural history and outcome of meconium peritonitis diagnosed antenatally compared with that diagnosed in neonates are becoming apparent. However, some features such as dilated bowel loops, ascites and pseudocyst can also develop later in the course of the disease[10],[11]. Hence, serial antenatal scans are required to assess the progress of peritonitis. Further the timing of diagnosis, whether in utero or in the neonatal period, is crucial, and impacts on the prognosis and outcome of the disease.

In general the simple variety has a better prognosis than the complex variety. Overall, about 50% of neonates diagnosed antenatally with complex form and about 20% of neonates with simple form require surgical intervention[10].

Due to the guarded prognosis in the complex variety, serial antenatal scans are necessary to assess the progress of meconium peritonitis as well as fetal growth and well-being. In the absence of an obstetric indication, these babies can be delivered vaginally at term. Parents are advised to deliver at a tertiary centre where neonatal intensive care and paediatric surgical facilities are available.

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